The impact of non-centralised surgical treatment on local recurrence, amputation rate and survival in patients with extremity soft tissue sarcoma

TL;DR

This study shows that treating extremity soft tissue sarcomas in a specialized unit leads to better outcomes than non-centralized care.

Contribution

The study evaluates surgical outcomes in a country without mandated sarcoma centers, emphasizing the benefits of centralized care.

Findings

Patients treated at specialized units had lower local recurrence rates (13.8%) compared to those treated at regional facilities (33.3–53.8%).

Specialized unit patients had higher 24-month survival rates (80.5%) than those managed at regional facilities (46.1–71.4%).

Amputation rates were lowest in the specialized unit group (2.8%) but differences were not statistically significant.

Abstract

This study aimed to evaluate the outcomes of surgical treatment for extremity soft tissue sarcomas in a country without a legislatively designated sarcoma center and to assess the impact of non-centralized surgical care on local recurrence, amputation rates, and patient survival.

A total of 97 patients treated over a five-year period at our orthopedic oncology unit, with a minimum follow-up of 24 months, were included. Patients were stratified into four groups according to the time point at which they were referred from regional hospitals to our department (before biopsy, after biopsy, after resection, and after local recurrence). Using descriptive statistics, we compared local recurrence rates, amputation rates, and overall survival among these groups.

Patients who were both diagnosed and initially operated on at the specialized orthopedic oncology unit had a substantially lower local recurrence rate (13.8%, CI [0.04, 0.23]. vs. 33.3–53.8%, CI [0.12, 0.72]) and a higher 24-month overall survival rate (80.5%, CI [0.67, 0.93] vs. 46.1–71.4%, CI [0.27, 0.90]) compared with those whose initial management occurred at regional facilities. Amputation rates varied between groups, with the lowest rate observed in patients diagnosed and treated at the specialized unit (2.8%, CI [0, 0.07] vs. 7.1–19.2%, CI [0, 0.36]); however, these differences did not reach statistical significance.

These findings are consistent with previously published data and support the centralization of care for extremity soft tissue sarcomas, which is associated with lower local recurrence and improved survival.

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